Estimating changes in antibiotic consumption with the introduction of doxycycline post-exposure prophylaxis in the United States.
Estimating changes in antibiotic consumption with the introduction of doxycycline post-exposure prophylaxis in the United States.
复制标题
估计美国引入强力霉素暴露后预防后抗生素消耗量的变化。
DOI：
10.1101/2023.09.20.23295787
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Grad,YonatanH
中科院分区：
文献类型：
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作者：
Roster,KirstinIOliveira;Grad,YonatanH
在一项针对接受 HIV 暴露前预防 (PrEP) 的男男性行为者、接受 HIV PrEP 的跨性别女性以及 HIV 感染者的随机对照试验中，多西环素作为暴露后预防 (doxy-PEP) 可以降低细菌性传播感染 (STI) 的风险。 1 人们担心，增加多西环素的摄入量可能会增加抗菌药物耐药性，包括耐多西环素的淋病奈瑟菌、金黄色葡萄球菌和肺炎链球菌。 2–4 抗生素的使用可能会随着 doxy-PEP 的引入而改变；估计这种变化可以为考虑抗菌素耐药性的风险和预防性传播感染的好处提供参考。我们估计了在几种 doxy-PEP 处方方案下美国抗生素消费量的一阶预期增长（附录第 1-2 页）。我们计算了通过 doxy-PEP 预防衣原体（多西环素）、淋病（头孢曲松）和梅毒（青霉素）感染而可以避免的抗生素每日剂量（以下简称剂量），以及消耗率（即每人每月四剂）和 DoxyPEP 试验中报告的相对风险估计（附录第 5 页）。 1我们估计，根据 DoxyPEP 试验的入组标准，美国有 0·8600 万人可能有资格接受 doxy-PEP（即，估计有 0·5300 万 HIV 感染者，以及目前正在接受 HIV PrEP 的估计有 0·3300 万人；附录第 5 页）；然而，我们没有包括他们的要求
Doxycycline as a post-exposure prophylaxis (doxy-PEP) reduced the risk of bacterial sexually transmitted infections (STIs) in a randomised controlled trial of men who have sex with men taking HIV pre-exposure prophylaxis (PrEP), transgender women taking HIV PrEP, and people living with HIV. 1 There is concern that increased consumption of doxycycline might increase antimicrobial resistance, including doxycycline-resistant Neisseria gonorrhoeae, Staphylococcus aureus, and Streptococcus pneumoniae. 2–4 Antibiotic use might change with the introduction of doxy-PEP; estimating this change could inform considerations of the risks of antimicrobial resistance and the benefits of STI prevention. We estimated the first-order expected increase in antibiotic consumption in the USA under several doxy-PEP prescribing scenarios (appendix pp 1–2). We accounted for defined daily doses, hereafter referred to as doses, of antibiotics that could be averted due to the prevention of chlamydia (doxycycline), gonorrhoea (ceftriaxone), and syphilis (penicillin) infections by doxy-PEP, with rates of consumption (ie, four doses per personmonth) and relative risk estimates as reported in the DoxyPEP trial (appendix p 5). 1We estimated that 0· 86 million people in the USA might be eligible for doxy-PEP under the enrolment criteria of the DoxyPEP trial (ie, up to an estimated 0· 53 million people living with HIV and up to an estimated 0· 33 million people currently taking HIV PrEP; appendix p 5); however, we did not include their requirement of an